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HMSA Neighborhood Centers

Take control of your health care by getting answers to your questions from someone who knows. Our representatives
can help you learn about your bill, make payments, check on a claim, or start a new plan.

Reconstructive or corrective services are a benefit of your plan when they’re required to restore, reconstruct,
or correct a bodily function that was lost, impaired, or damaged due to an illness or injury. HMSA plans don’t cover
purely cosmetic services, that is, surgery or supplies that are primarily done to improve your natural appearance (for example,
hair transplants, electrolysis, ear or body piercing), but don’t restore or improve a physical function. For most plans,
complications from non-covered cosmetic surgery aren’t covered.

Most HMSA plans cover breast reconstruction when a mastectomy is performed as well as surgery for reconstruction of the other breast
to produce a symmetrical appearance (including prostheses). Treatment of complications of the mastectomy and reconstruction, including
lymphedema (post-treatment swelling that occurs), is also covered.

Services to correct developmental abnormalities present from birth that prevent you from having normal, essential bodily function would
also be covered. For example, cleft lip/cleft palate surgery in a newborn that has difficulty breastfeeding may be performed so that your
child may feed without difficulty.

Certain reconstructive surgery and services may be covered if your condition meets HMSA’s payment and medical policy criteria. These
may be available only if precertification is obtained. For more information, please review
Prior Approval for Medical Services (Precertification) for
information about the precertification process. Also, review the following medical policies if they apply to the service you’re requesting: